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Stress Condition on a Restricted Sodium Diet Using Umami Substance (L-Glutamate) in a Pilot Randomized Cross-Over Study

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Stress Condition on a Restricted Sodium Diet Using Umami Substance (L-Glutamate) in a Pilot Randomized Cross-Over Study foods Article Stress Condition on a Restricted Sodium Diet Using Umami Substance (L-Glutamate) in a Pilot Randomized Cross-Over Study Tamami Iwamoto 1,* , Andrea Wakita 2, Saiko Shikanai 3, Hideki Matsumoto 2, Mariko Hirota 2, Hisayuki Uneyama 2, Vu Thi Thu Hien 4 and Shigeru Yamamoto 1 1 Department of Food and Nutritional, Faculty of Human Life, Jumonji University, Saitama 352-8510, Japan; [email protected] 2 Ajinomoto Co., Inc., Kanagawa 210-8681, Japan; [email protected] (A.W.); [email protected] (H.M.); [email protected] (M.H.); [email protected] (H.U.) 3 Asian Nutrition and Food Culture Research Center, Saitama 352-8510, Japan; [email protected] 4 National Institute of Nutrition, Hanoi 84, Vietnam; [email protected] * Correspondence: [email protected]; Tel.: +81-48-477-0555; Fax: +81-48-478-9367 Abstract: Hypertensive patients who adopt a sodium-restricted diet have difficulty maintaining this change, and this could increase stress. On the other hand, soup rich in umami substances (dashi) was reported to reduce indexes of anxiety and stress. The objective of this study was to measure mood and physiological stress indexes during administration of a sodium-restricted diet with and without an umami substance (free L-glutamate) by a cross-over randomized, single-blind, placebo-controlled trial in Japanese female university students. The baseline was measured for 5 days followed by Citation: Iwamoto, T.; Wakita, A.; a sodium-restricted diet intervention phase that lasted for 10 days. The Profile of Mood States Shikanai, S.; Matsumoto, H.; Hirota, questionnaire was administered, a stress marker in saliva (chromogranin-A) was measured, and the M.; Uneyama, H.; Hien, V.T.T.; amount of sodium intake was confirmed from 24 h urine collection samples. Results showed that Yamamoto, S. Stress Condition on a the sodium reduction was verified by 24 h urine excretion. The percentage of change in the stress Restricted Sodium Diet Using Umami marker from the baseline showed that the stress level in group without the umami substance was Substance (L-Glutamate) in a Pilot significantly higher than that in the group with the umami substance (p = 0.013) after receiving a Randomized Cross-Over Study. Foods 2021, 10, 1739. https://doi.org/ sodium-reduced diet for 6 or more days, indicating that stress was alleviated. This study suggested 10.3390/foods10081739 that umami substances might help to ameliorate stress during a sodium-reduced diet, especially in the initial phase. Academic Editor: Jean-Xavier Guinard Keywords: stress; umami substances; restricted sodium diet; cross-over Received: 21 June 2021 Accepted: 25 July 2021 Published: 28 July 2021 1. Introduction COVID-19, a new type of infectious disease, reminded us that prevention of non- Publisher’s Note: MDPI stays neutral communicable diseases (NCDs) is an issue that we should solve beyond the boundaries with regard to jurisdictional claims in of emerging and developing countries [1]. In 2013, WHO established the NCD Global published maps and institutional affil- Monitoring Framework and set seven goals for NCD prevention [2]. Among them, the only iations. specific nutrient intake target is salt reduction, and it calls on member countries to aim for a 30% reduction in salt intake from 2011 to 2025. Since then, many initiatives on salt reduction have been launched, accelerating the global salt-reduction movement. However, as of 2020, no country has achieved this goal [3]. For instance, the Japanese National Copyright: © 2021 by the authors. Nutrition and Health Survey 2019 reported that even though salt intake in Japanese was Licensee MDPI, Basel, Switzerland. reduced from 10.7 to 10.1 g/day during the period 2009–2019 [4], the intake is still almost This article is an open access article twice as much as the WHO recommendations of less than 5 g per day [5]. distributed under the terms and The latest analysis report of the Global Burden of Disease (GBD) has just been pub- conditions of the Creative Commons lished in The Lancet. As of 2019, primary care management and reductions in salt intake are Attribution (CC BY) license (https:// known to be potentially effective in reducing the burden of critical risk factors [6]. However, creativecommons.org/licenses/by/ 4.0/). salt not only improves the taste of food but is also used to preserve and flavor foods and to Foods 2021, 10, 1739. https://doi.org/10.3390/foods10081739 https://www.mdpi.com/journal/foods Foods 2021, 10, 1739 2 of 11 improve yeast fermentation in dough [7–9], making a reduction a major challenge for the food industry. The committee on strategies to reduce sodium intake in the United State sug- gested the possibility of replacing some of the salt in food with other tastes or flavors [10]. An example is the addition of umami taste ingredients, dominantly composed of a building block of dietary protein, L-glutamate (an amino acid). Free L-glutamate can maintain food palatability with a lowered overall sodium amount in a food item [11–14]. In fact, free L-glutamate is being used in sodium-restricted diets such as for schizophreniform patients in hospital [15]. On the other hand, Kawano et al. have demonstrated that hypertensive patients who receive a sodium-restricted diet after diagnosis have difficulty maintaining the diet [16]; thus, in these subjects, having to continue with the diet could increase stress. Previous studies [17–20] showed improvement in mood state when subjects have an intake of dried bonito broth (dashi), which is rich in umami substances. For instance, in a randomized placebo-controlled human trial, it was found that dashi improved mood states and improved concentration significantly [17]. Another study reported that dashi not only improved the mood state but also decreased 8-hydroxy-20-deoxyguanosine, an oxidative stress marker [19]. This evidence may indicate the possibility of umami taste substances having a positive benefit for healthy eating. Several authors have reported the relationship between diet and stress; most of these studies are on the effects of psy- chological/physiological stress on dietary choices [21,22] but not on the effect of having several days of a sodium-reduced diet on stress in human studies. Our hypothesis is that an umami substance could be used as an approach to enhance the taste and palatability of a sodium-restricted diet and reduce psychological and physiological stress. Therefore, we investigated the effects of sodium-reduced-diet intake on the measurement of mood using the Profile of Mood States (POMS) questionnaire and measured physiological stress by testing the concentration of a saliva sympathetic system marker, chromogranin-A (CgA pmol/mg protein), during a sodium-restricted diet with and without the addition of umami substances in the foods. It is well known that salivary CgA (pmol/mg protein) changes more rapidly and more sensitively to psychological stressors than salivary cortisol does [23,24], and it has the advantage for the participants of being a noninvasive method. 2. Materials and Methods This study was approved by the Ethics Committees of Jumonji University (2012-008 and 2012-008-2), and Ajinomoto Co., Inc. (2012-008). Written consent was obtained from all subjects. This study was registered at UMIN-CTR Clinical Trial (UMIN000020514). 2.1. Subjects Thirty-one Japanese female university students were recruited by voluntary participa- tion. Women between 18 and 35 years old, with a regular menstrual cycle, who were not pregnant or lactating, without a habit of exhausting exercise, without chronic diseases, and without food allergies participated in the study. 2.2. Study Design It was a cross-over randomized, single-blind, placebo-controlled trial. Participants were randomly divided into group A or group B and assigned to start a sodium-restricted diet without an umami substance as the control group (group A) or a sodium-restricted diet with an umami substance as the Glu group (group B) for ten days. Before dividing into the two groups, participants received a diet with more than 4000 mg of sodium for 5 days as the baseline phase to standardize the sodium intake before the intervention phase. This amount of sodium was close to the Japanese diary intake [4]. 2.3. Diet Intervention During the 5-day baseline and 10-day intervention phases, researchers provided participants with breakfast, lunch, dinner, snacks, and beverages. For snacks and beverages, the same brand of each item was purchased. Participants took the whole meals to eat Foods 2021, 10, 1739 3 of 11 at home or university, and they were instructed to eat all their food during the baseline and intervention phases, respectively. Snacks were optional. They were given a diary file to record all uneaten food portions (example: 1/4 main dish not eaten), snacks eaten, approximate amount of urine missed during collection, and comments regarding the study or whether their mood/physical condition was different from usual. The meals for lunch and dinner for the baseline and intervention were on 4-day menu cycles. The meals for breakfast and snacks were prepared or bought by Jumonji University. Main and side dishes for lunch and dinner were prepared for each participant in individual bags by the food factory Anshin Koubo Ltd., Yamagata, Japan, following standardized recipes and stored at −20 ◦C. The main and side dish portions were the same for all participants, but a dietitian adjusted individual dietary energy requirements by increasing or decreasing the amount of plain white rice and snacks. Energy and nutrients were calculated using the Excel Eiyokun software Ver. 6.0 (Kenpakusha Co., Ltd., Tokyo, Japan), based on the table of nutrient contents published by the Japanese Science and Technology Agency (5th edition). Before starting the study, randomized food samples from all diets (baseline, sodium-restricted diet without and with umami substance) were taken to analyze free L-glutamate, sodium, and potassium content at the Ajinomoto Co., Inc., laboratory.
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